Updated response assessment criteria for high-grade glioma: beyond the MacDonald criteria

2017 ◽  
Vol 6 (4) ◽  
pp. 37-37 ◽  
Author(s):  
Mayur Sharma ◽  
Rupa Gopalan Juthani ◽  
Michael A. Vogelbaum
Keyword(s):  
High Grade Glioma ◽  
Response Assessment ◽  
Assessment Criteria ◽  
High Grade ◽  
Macdonald Criteria

Current Concepts in Brain Tumor Imaging

2012 ◽  
pp. 119-124
Author(s):  
Andrew D. Norden ◽  
Whitney B. Pope ◽  
Susan M. Chang
Keyword(s):  
Standard Treatment ◽  
Tumor Imaging ◽  
High Grade Glioma ◽  
Response Assessment ◽  
Recurrent Glioblastoma ◽  
High Grade ◽  
Resonance Imaging ◽  
Imaging Tool ◽  
Magnetic Resonance Imaging Mri ◽  
New Criteria

Overview: Magnetic resonance imaging (MRI) is the most useful imaging tool in the evaluation of patients with brain tumors. Most information is supplied by standard anatomic images that were developed in the 1980s and 1990s. More recently, functional imaging including diffusion and perfusion MRI has been investigated as a way to generate predictive and prognostic biomarkers for high-grade glioma evaluation, but additional research is needed to establish the added benefits of these indices to standard MRI. Response critieria for high-grade gliomas have recently been updated by the Response Assessment in Neuro-Oncology (RANO) working group. The new criteria account for nonenhancing tumor in addition to the contrast-enhancing abnormalities on which older criteria relied. This issue has recently come to the fore with the introduction of the antiangiogenic agent bevacizumab into standard treatment for recurrent glioblastoma. Because of its potent antipermeability effect, contrast enhancement is markedly reduced in patients who receive bevacizumab. The RANO criteria also address the phenomenon of pseudoprogression, in which there may be transient MRI worsening of a glioblastoma following concurrent radiotherapy and temozolomide.

scholarly journals Current standards and new concepts in MRI and PET response assessment of antiangiogenic therapies in high-grade glioma patients

2014 ◽  
Vol 17 (6) ◽  
pp. 784-800 ◽  
Author(s):  
M. Hutterer ◽  
E. Hattingen ◽  
C. Palm ◽  
M. A. Proescholdt ◽  
P. Hau
Keyword(s):  
High Grade Glioma ◽  
Response Assessment ◽  
High Grade ◽  
Antiangiogenic Therapies ◽  
New Concepts ◽  
Current Standards

scholarly journals Dynamics of circulating hypoxia-mediated miRNAs and tumor response in patients with high-grade glioma treated with bevacizumab

2016 ◽  
Vol 125 (4) ◽  
pp. 1008-1015 ◽  
Author(s):  
Tali Siegal ◽  
Hanna Charbit ◽  
Iddo Paldor ◽  
Bracha Zelikovitch ◽  
Tamar Canello ◽  
...  
Keyword(s):  
Tumor Response ◽  
High Grade Glioma ◽  
Response Assessment ◽  
High Rate ◽  
Normal Brain ◽  
High Grade ◽  
Serum Samples ◽  
Antiangiogenic Effect ◽  
Bevacizumab Treatment ◽  
Fluid Attenuated Inversion Recovery

OBJECTIVE Bevacizumab is an antiangiogenic agent under investigation for use in patients with high-grade glioma. It produces a high rate of radiological response; however, this response should be interpreted with caution because it may reflect normalization of the tumor vasculature and not necessarily a true antitumor effect. The authors previously demonstrated that 4 hypoxia-mediated microRNAs (miRNA)—miR-210, miR-21, miR-10b, and miR-196b—are upregulated in glioma as compared with normal brain tissue. The authors hypothesized that the regulation and expression of these miRNAs would be altered in response to bevacizumab treatment. The object of this study was to perform longitudinal monitoring of circulating miRNA levels in patients undergoing bevacizumab treatment and to correlate it with tumor response. METHODS A total of 120 serum samples from 28 patients with high-grade glioma were prospectively collected prior to bevacizumab (n = 15) or temozolomide (TMZ; n = 13) treatment and then longitudinally during treatment. Quantification of the 4 miRNAs was evaluated by real-time polymerase chain reaction using total RNA extracted from the serum. At each time point, tumor response was assessed by Response Assessment in Neuro-Oncology criteria and by performing MRI using fluid attenuated inversion recovery (FLAIR) and contrast-enhanced images. RESULTS As compared with pretreatment levels, high levels of miR-10b and miR-21 were observed in the majority of patients throughout the bevacizumab treatment period. miR-10b and miR-21 levels correlated negatively and significantly with changes in enhancing tumor diameters (r = −0.648, p < 0.0001) in the bevacizumab group but not in the TMZ group. FLAIR images and the RANO assessment did not correlate with the sum quantification of these miRNAs in either group. CONCLUSIONS Circulating levels of miR-10b and miR-21 probably reflect the antiangiogenic effect of therapy, but their role as biomarkers for tumor response remains uncertain and requires further investigation.

scholarly journals P04.05 Improving treatment response assessment of high grade glioma: classification of lesion area into tumor and non-tumor components

2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii40-iii41
Author(s):  
D. T. Blumenthal ◽  
M. Artzi ◽  
G. Liberman ◽  
Bokstein ◽  
O. Aizenstein ◽  
...  
Keyword(s):  
Treatment Response ◽  
High Grade Glioma ◽  
Response Assessment ◽  
High Grade ◽  
Lesion Area ◽  
Treatment Response Assessment ◽  
Glioma Classification

Updated Response Assessment Criteria for High-Grade Gliomas: Response Assessment in Neuro-Oncology Working Group

2010 ◽  
Vol 28 (11) ◽  
pp. 1963-1972 ◽  
Author(s):  
Patrick Y. Wen ◽  
David R. Macdonald ◽  
David A. Reardon ◽  
Timothy F. Cloughesy ◽  
A. Gregory Sorensen ◽  
...  
Keyword(s):  
Contrast Enhancement ◽  
Working Group ◽  
Response Assessment ◽  
Response To Therapy ◽  
Response Criteria ◽  
Antiangiogenic Agents ◽  
High Grade ◽  
Macdonald Criteria ◽  
Fluid Attenuated Inversion Recovery ◽  
High Grade Gliomas

Currently, the most widely used criteria for assessing response to therapy in high-grade gliomas are based on two-dimensional tumor measurements on computed tomography (CT) or magnetic resonance imaging (MRI), in conjunction with clinical assessment and corticosteroid dose (the Macdonald Criteria). It is increasingly apparent that there are significant limitations to these criteria, which only address the contrast-enhancing component of the tumor. For example, chemoradiotherapy for newly diagnosed glioblastomas results in transient increase in tumor enhancement (pseudoprogression) in 20% to 30% of patients, which is difficult to differentiate from true tumor progression. Antiangiogenic agents produce high radiographic response rates, as defined by a rapid decrease in contrast enhancement on CT/MRI that occurs within days of initiation of treatment and that is partly a result of reduced vascular permeability to contrast agents rather than a true antitumor effect. In addition, a subset of patients treated with antiangiogenic agents develop tumor recurrence characterized by an increase in the nonenhancing component depicted on T2-weighted/fluid-attenuated inversion recovery sequences. The recognition that contrast enhancement is nonspecific and may not always be a true surrogate of tumor response and the need to account for the nonenhancing component of the tumor mandate that new criteria be developed and validated to permit accurate assessment of the efficacy of novel therapies. The Response Assessment in Neuro-Oncology Working Group is an international effort to develop new standardized response criteria for clinical trials in brain tumors. In this proposal, we present the recommendations for updated response criteria for high-grade gliomas.

scholarly journals Standardized MRI assessment of high-grade glioma response: a review of the essential elements and pitfalls of the RANO criteria

2015 ◽  
Vol 3 (1) ◽  
pp. 59-67 ◽  
Author(s):  
Dewen Yang
Keyword(s):  
High Grade Glioma ◽  
Response Assessment ◽  
Essential Elements ◽  
Response Criteria ◽  
High Grade ◽  
Novel Treatments ◽  
Sufficient Detail ◽  
Volume Measurements ◽  
To Come ◽  
Made In

Abstract Accurately evaluating response in the treatment of high-grade gliomas presents considerable challenges. This review looks at the advancements made in response criteria while critically outlining remaining weaknesses, and directs our vision toward promising endpoints to come. The 2010 guidelines from the Response Assessment in Neuro-Oncology (RANO) working group have enhanced interpretation of clinical trials involving novel treatments for high-grade glioma. Yet, while the criteria are considered clinically applicable to high-grade glioma trials, as well as reasonably accurate and reproducible, RANO lacks sufficient detail for consistent implementation in certain aspects and leaves some issues from the original Macdonald guidelines unresolved. To provide the most accurate assessment of response to therapeutic intervention currently possible, it is essential that trial oncologists and radiologists not only have a solid understanding of RANO guidelines, but also proper insight into the inherent limitations of the criteria. With the expectation of improved data collection as a standard, the author anticipates that the next high-grade glioma response criteria updates will incorporate advanced MRI methods and quantitative tumor volume measurements, availing a more accurate interpretation of response in the future.

scholarly journals Response assessment in paediatric high-grade glioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group

2020 ◽  
Vol 21 (6) ◽  
pp. e317-e329 ◽  
Author(s):  
Craig Erker ◽  
Benita Tamrazi ◽  
Tina Y Poussaint ◽  
Sabine Mueller ◽  
Daddy Mata-Mbemba ◽  
...  
Keyword(s):  
Working Group ◽  
High Grade Glioma ◽  
Response Assessment ◽  
High Grade
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